Ch. 5 The Physician-Patient Relationship Flashcards
1
Q
Physician-Patient Relationship
A
- Both must agree to form relationship for there to be contract for services (implied contract)
- Under contract for services, patient can expect doctor to provide medical service for as lone as necessary
- Patient must confide truthfully to physician
- Physician is not liable if critical information withheld - Patient information is confidential
- Includes overheard or read
2
Q
Physician’s Rights
A
- Right to select patients
- Right to refuse service to patients
- Right to determine type of services provided
- Right to be paid for services rendered
- Right to withdraw from relationship
- Right to vacation and time off
3
Q
Physician’s Responsibilities
A
- Be professionally competent
- Treat all patients equally
- Not to take “kickbacks” of money or other benefits in exchange for referrals
- Follow AMA code of ethics
4
Q
Physicians’ Duties
A
- Patient welfare above financial interests
- Professional courtesy
- Report any unethical conduct by other physicians
- Recommend second opinions when necessary
- Do not engage in sexual conduct with a patient during the physician-patient relationship
- Do not treat family members except in emergencies
5
Q
Professional practice duties during a medical emergency
A
- Cannot ethically or legally turn away patient in an emergency situation
- If unable to treat patient, then must call for emergency assistance
- Patients cannot be turned away if indigent or uninsured
6
Q
Duty to Treat Indigent Patients
A
- “Dumping crisis”
- EMTALA— Requires hospitals to stabilize a patient during an emergency situation
- Require patient stabilization in an emergency - Physician has right to select which patients to treat
- Physician does not have right to drop or abandon patients once treatment is agreed upon
7
Q
Duty Not to Abandon a Patient
A
- Once physician agrees to take care of patient, contract may not be improperly terminated
- Physician may be charged with abandonment if formal notice of withdrawal is not given
- Civil wrong, or tort - Physician must allow patient time to seek service of another physician
- Licensed health care providers are also subject to this principle
- Dentists
- Physician assistants
- Nurse practitioner
8
Q
Noncompliant
A
- Fails or refuses to cooperate
9
Q
Incompetent
A
- Unable to provide for own needs
- Status decided by court of law
10
Q
Duty to Treat Patients with AIDS
A
- Unethical to refuse to treat, work with, or provide housing for person who is HIV positive or has AIDS
- Physician, by law, must make full report to state about any patient who is HIV positive or has AIDS
- Ethical dilemma
- Report required regardless of consequence - Ethical considerations
- Persuade patient to inform his or her partner
- Notify authorities if concerned that patient will not inform others
- As last resort, notify patients partner
11
Q
Exposure of Health Care Workers to Patient’s Blood
A
- At 0.3 percent risk of contracting HIV after blood exposure, according to the CDC
- HIV testing of patient’s blood allowed in some states
12
Q
Restrictions on HIV-Infected Health Care Workers
A
- Various recommendations, but not rules
- AMA
- American Academy of Orthopedic Surgeons
- Federation of State Medical Boards
- Strongest statement
- Recommends names of HIV-infected health care workers be reported- CDC - Testing all health care workers would be prohibitive - No ethical duty to disclose HIV status if no significant risk presented to patients
13
Q
Duty to Properly Identify Patients
A
- Identify patient both by stating his or her name and examining any other identification
- Medical wrist band
- Driver’s license
- Use discretion with patient sign-in sheets to protect confidentiality
- Have patient state name
14
Q
Duty to Respect Confidentiality
A
- Speak in low voice
- Glass enclosure should separate front desk receptionist from waiting room
- Sign-in sheet should consider protection from subsequent patients
15
Q
Duty to Tell the Truth
A
- Many believe principles of justice apply when dealing with truth-telling
- Try to determine the “just” action for patient
- Just action may be at variance with obligation of confidentiality
- Confidentiality may be overridden when life or safety of patient is endangered
16
Q
Patient’s Rights
A
- Right to confidentiality
- Privileged communication - Right to give informed consent
- Right to privacy
- Right to be informed of advantages and potential risks of treatment
- Right to refuse treatment
17
Q
Confidentiality
A
- All information and records about treatment will be kept confidential by physician and staff unless consent to release is obtained
- Breach of confidentiality is both unethical and illegal - Medical Patients Rights Act
- All patients are entitled to have privacy respected and medical records handled confidentiality - Privileged communication
- Confidential information told to a physician or attorney by a patient - HIPAA regulations must be observed (Ch. 10)
18
Q
Patient Self-Determination Acts
A
- Advance directive
- Living will
- “Do Not Resuscitate” order- Durable power of attorney - Uniform Anatomical Gift Act
- Patient may revoke these documents
- Family may consent on the deceased patient’s behalf
19
Q
Minor
A
- Person under the age of maturity (18 is most states)
20
Q
In loco parentis
A
- Person assigned by court to stand in place of parents
21
Q
Parents patriae
A
- State takes over care for minor
22
Q
Mature minor
A
- Person in mid to late teens who, for health care purposes, is considered mature enough to comprehend physician recommendations and give informed consent
23
Q
Emancipated minor
A
- Person in mid to late teens who legally lives outside parents’ or guardian’s control
- Proof should be included in medical record
24
Q
The Patient’s Responsibilities
A
- Follow physician’s instructions
- Make follow-up appointments and monitor treatment and medication use if requested by physicians
- Be honest
- Pay for medical services
- Provide informed consent
25
Q
Consent
A
- Voluntary agreement by patient to allow medically trained person to touch, examine, and perform treatment
- Two types
- Informed (expressed) consent
- Implied consent
26
Q
Informed or expressed consent
A
- Patient agrees to course of treatment after being told consequences of having or not having certain procedures and treatments
- Signature indicates patient understands limits and risks involved as explained by physician
27
Q
Doctrine of Informed Consent: Requires physician to explain in understandable language
A
- Diagnosis
- Nature of proposed treatment
- Advantages and risks or treatment
- Alternative treatments available to patient
- Potential outcomes of treatment
- What might occur-risks and benefits-if treatment is refused
28
Q
Implied Consent
A
- Patient indicates by behavior that he or she accepts procedure
- Offers arm to have blood sample drawn - Consent is assumed in medical emergencies
29
Q
Exceptions to Consent
A
- Need not inform of commonly known risks
- Need not inform if disclosure of risks may be detrimental to patient
- Need to inform if patient asks physician not to disclose risks
- Not required to restore patients to original health
- Cannot elicit cure for every patient
- Cannot guarantee successful results of every treatment
30
Q
Refusal to Grant Consent
A
- Adult patients conscious and mentally capable have right to refuse any medical or surgical treatment
- Refusal must be honored no matter what patient’s reasoning
- Failure to respect right of refusal could result in liability for assault and battery
31
Q
Role of Health Care Consumer
A
- Do not self-medicate
- Be honest with physician
- Assist physician in prevention of medical errors
